An Australian study published last month looks at mandatory helmet laws and how the health benefits of increased safety balance against the health costs due to decreased cycling. Here’s the abstract:

A model is developed which permits the quantitative evaluation of the benefit of bicycle helmet laws. The efficacy of the law is evaluated in terms of the percentage drop in bicycling, the percentage increase in the cost of an accident when not wearing a helmet, and a quantity here called the “bicycling beta.” The approach balances the health benefits of increased safety against the health costs due to decreased cycling. Using estimates suggested in the literature of the health benefits of cycling, accident rates and reductions in cycling, suggest helmets laws are counterproductive in terms of net health. The model serves to focus the bicycle helmet law debate on overall health as function of key parameters: cycle use, accident rates, helmet protection rates, exercise and environmental benefits. Empirical estimates using US data suggests the strictly health impact of a US wide helmet law would cost around \$5 billion per annum. In the UK and The Netherlands the net health costs are estimated to be \$0.4 and \$1.9 billion, respectively.

I agree with wuss. No facts are going to get in the way of people’s opinons. It should be a personal choice (except in the case of minors, I think). We had a mandatory helmet law here in Austin for several years in the 90s, and it was repealed due to popular demand.

We know the risks, we take them, the same way a person who chooses to parachute out of an airplane does, and the person who scuba-dives shark infested reefs does. We do it for fun and we want to do it the way we want to, not the way some politician looking to score points wants to.

I’ve begun not wearing a helmet. We have mandatory laws here in Vancouver, Canada but I’m not sure what the fine is. As far as I can tell the police don’t enforce it regularly but I have heard of the occasional ticket.

I’ve read a fair bit on this subject recently and I find the science far more convincing then the wishful thinking. I’ve never found them comfortable. They are sweaty (and I sweat more than some). But the argument that mandatory helmet laws have an overall negative impact on the general health of a society seems to be borne out in studies. The argument that they may be ineffective as a safety measure is supported by science as well. It’s been suggest that rotational head injuries (one of the more severe head injuries) may be more likely when wearing a helmet due to the increased surface area.

Cycling is a safe activity and the more cyclist out there the safer we all are.

> We know the risks, we take them, the same way a person who chooses to parachute out of an airplane does, and the person who scuba-dives shark infested reefs does.

But those are rather misleading examples. Cycling isn’t that dangerous, with or without a helmet. If you use the more realistic “We know the risks, we take them, the same way a person who chooses to walk up and down stairs, and the person who takes a shower does”, then it becomes clearer why special protective clothing isn’t needed for cycling.

In general, I believe laws like this are not so much intended to protect cyclists, but rather to protect society from the costs of treating head-injured cyclists and maintaining them on life-support. That at least is why mandatory helmet laws for motorcyclists have been passed, and why mandatory seat belt (and later airbag) regulations were passed.

I don’t think the greater speed of motorcycles makes them more dangerous than bicycles in terms of head injuries. You can die from falling over on your bicycle at a standing stop and hitting your head on the pavement; the one really serious bike accident I’ve witnessed happened exactly that way — a guy lost his balance and fell, hitting his head. He went into convulsions and was vomiting, unconscious with his eyes wide open. I left before the ambulance arrived (there was a crowd of people around him) so don’t know what the final outcome was, but it made a big impression on me; he wasn’t wearing a helmet. Of course there’s no way to know if a helmet would have saved him, but I’ve had a few bad spills myself where my helmet cracked and it was nice to know it was the helmet that broke and not my skull.

With motorcycles, I guess you could compare head-injury death rates from states like New Hampshire that don’t have a helmet law with other states that do, and I’m sure those studies have been done. With bicycles it’s not as clear-cut. I agree that requiring helmets is likely to discourage bike use on the part of some populations (mainly those who can’t afford a helmet or think helmets are silly), and thus society would pay the cost of a less-healthy population (more obesity, etc.). That cost has to be balanced against the reduction in serious head injuries, if indeed it has been demonstrated that helmets provide such a benefit to cyclists.

So far I have yet to see a non biased comprehensive study proving or disproving that helemts actually work or don’t work. There is plenty of antedoctal evidence on both sides of the argument. I feel that mandatory helmet laws are counter productive and are in many cases used as a form of harassment. I have seen some independent testing done of various helmets to see if they met the basic CSPC standards…and many of them didn’t.

To me it is a personal choice. If you want to mandate something, mandate life in prison for repeat DUI offenders.

Let’s be clear. This study does not say wearing a helmet has no benefit. It says that mandatory helmet laws create more healthcare costs for a state than the absence of those laws. So, this has nothing to do with whether or not an individual should choose to wear a helmet. I mention this because this study has popped up all over the place, and people constantly make either “more proof that I should not wear a helmet!” or “I still choose to wear a helmet!” comments. That’s nice and everything, but this research is about what’s cheaper, not what’s safer.

There is a world of difference between a seat belt, a motorcycle helmet and a bike helmet. The latter was never intended to prevent serious head injury or serious injury of any sort and even those who promote them know full well that they won’t. And if it cracks it doesn’t mean your head would have if you were not wearing one. It means the the helmet failed. You’re head may never have actually bumped into anything at all had the mass of your head not been increased by the helmet, or had the helmet not provided you with a false sense of security (if you want to get into silly speculation).

It is the fear mongering from the pro-helmet law crowd with their lack of or flawed science that scares people off of bicycles because they see them as dangerous. If you want to ride and you don’t want to wear a helmet, for whatever reason, even with mandatory helmet laws you are likely to ride anyway. If you are made to fear riding you will not.

I think the whole argument about health care costs rising due to increased head injuries is bunk. We all know why the cost of health care has skyrocketed: insurance companies, drug companies, hospital companies, unscrupulous doctors, unscrupulous lawyers, etc. Blaming us, the victims, is a classic excuse/scapegoat used by the powers that be.

We have some of the best doctors and medical technology in the world, but the way we deliver that health care to the public is shameful. We have a corrupt system, based on greed, that basically treats medical care as a privilege instead of a right. Health care costs have no place in the helmet argument.

It’s also about what’s better for cyclists as a group, rather than as an individual. The potential benefit to me of wearing a helmet is considerable, but to society as a whole, it may be counterproductive, both in terms of overall costs to the public purse, and the size of the cycling herd to protect us all.

Alan (Not the site owner) – Nice analogies. I generally don’t wear a helmet in the shower, but if I was sprinting in one, I probably would! Everyday cycling is just like doing everyday stuff, while the everyday racing wannabe cycling that you often see isn’t quite so risk free.

Alan (not the site owner), sky diving and scuba diving may be a lot riskier than riding your bike on the street, but that is why I chose those examples. Because these two activities, as risky as they are, don’t create any controversy (as far as I know) compared to cycling helmets. That is my point; when you look at those activities, nobody gives a damn, so why not leave the cycling helmet thing alone.

On the other hand riding a bike is much riskier than walking up and down the stairs and taking a shower, so that is a poor comparison. Unless, of course, you have data showing that more people die or are injured in the shower or climbing stairs than riding bikes. I don’t know what those figures are, but I’m sure they are available.

bentguy in vancouver wrote: “And if it cracks it doesnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t mean your head would have if you were not wearing one. It means the the helmet failed.”

Actually it means the helmet did its job: they’re supposed to crack when you fall on them hard enough, as they’re dissipating all that energy. It takes a pretty serious fall to crack a helmet, and both the accidents I had were bad. My glove on one hand was shredded to pieces in one of those crashes too, which reminded me again what a good idea it is to wear them. I’ve been bicycling for 40 years, and over a period that long you’re bound to have at least one or two big accidents that make you rethink your safety standards. I never wore a helmet until my 30s but I personally would never get on a bike now without a helmet or gloves. That said, I don’t think mandatory helmet laws are a great idea, except maybe for kids.

From the comments already posted, I see that there is little point in trying to change anyone’s mind about compulsory helmet laws. Here in Australia, online arguments still occur now and then as a few individuals rail against the helmet laws. The vast majority of cyclists are bored by such arguments and just strap on their helmets and ride. Far more common on Australian web forums are anecdotal reports of cycling accidents in which the everyone was very thankful that the victim was wearing a helmet.

Regarding the study in question, I’ll point out a few flaws. Firstly, the author assumes that mandatory helmet laws reduce the level of cycling participation by 10%. Certainly there is some fairly sketchy evidence that when the helmet laws were introduced across Australia between 1990 and 1992, there was a transient drop in cycling participation lasting about two years. However, there is no evidence at all that the drop in cycling persisted, and levels of cycling were back to what they were pre-helmet laws by 1995. Cycling participation has been increasing steadily since, except for the last few years when it has really started to take off. In the 21st Century in Australia, the requirement to (and wisdom of) wearing a helmet is just taken for granted. Helmets are cheap, you can buy them in supermarkets. Thus I would dispute the premise that, after an initial societal adjustment period, that the legislative requirement to wear a helmet significantly reduces cycling participation. There is no evidence for this.

The other obvious flaw is that the author assumes that no-one wears helmets prior to the introduction of a compulsory helmet law, and that everyone wears a helmet after its introduction. This is completely unrealistic, and evidence from the US and UK suggests that a significant number of cyclists wear helmets even if the law does not require it. Changing this parameter significantly changes the results. It is a bit disingenuous of the author to have assumed 0% and 100% helmet wearing before and after the introduction of helmet laws. Quite naughty, in fact.

Oh, the author quotes dollar benefits (or disbenefits) for cycling helemt laws. However these monetary figures are predicated on the assumption of $1 of health benefit for every kilometre of cycling. Yes, cycling confers health benefits, but $1 per kilometre is an absurdly high figure – and thus the dollar figures quoted in teh paper are vastly inflated.

you can look at the body of research on bicycle helmets. you can consider the flaws in the various studies and decide what you think they mean. i’ve done that. taken as whole, i read the research to indicate that mandatory helmet laws are a bad idea, at least in the United States. We’re too libertarian and oppositional. :-))

i’m not going to stray from the topic of the research, so i won’t say anything about whether certain people should choose to wear a helmet or not. i think we already covered that in a different thread.

Where is the law that protects me from cyclists who wear really old white cycle shorts that you can see through? I find them very distracting and one day, they are going to cause me to crash. Hey, now I think about it, maybe good looking men should be made illegal, they distract me to. Oh yeah, and cats, I love cats and they distract me…..

People. Just ride your bike. Helmet or no. Support legislation that gets more people on their bikes, and keep the Big Brother protectionism out of it.

I’m an Australin cyclist, an aged pensioner who rides to town every day 24km round trip. A couple of years ago I rode my bike from my home on the west coast, to Alice Springs, via the nullabor plain,; the home via the top end. A round trip of 8000 km.

So I can speak with some authority on the wearing of helmets. Chlldren almost never wear them, especially those in the lower socio-ecomic scale. I cannot recall ever seeing an aboriginal kid wearing a helmet.

The majority of adults that cycle do wear them.

Personally I have my doubts about their efficacy. I tend to travel somewhat slower than a marathon runner, and I ride a greenspeed recumbent, which is almost impossible to tip over.

The only time that I was ever stopped by a cop for not wearing a helmet. I answered him in Russian, ( The words of a song I knew) . He just threw his hands up and walked away.
Terry

For me, I usually but not always wear the foam beanie. I figure a little cushioning is better than nothing. Mostly I make sure I’m aware, the brakes work, and no SUV is turning into my lane! On long, slow, hot climbs, I frequently, take off the helmet and put on a cap. I rarely where a helmet when piloting our Greenspeed recumbent trike, even on pretty big descents. Oh well.

I did take to wearing a helmet on most rock climbs I did–except for the so-called “sport” variety where all the protection is bolted. Even so, in my youth I climbed both El Capitan and Half Dome sans protective dome.

Erik Sandblom said:
Bennelong, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIt is a bit disingenuous of the author to have assumed 0% and 100% helmet wearing before and after the introduction of helmet laws.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â

DonÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t you have this backwards? Assuming helmets are good for public health, those assumptions should produce the maximum health benefit of a helmet law.
**************************
Yes, I would have thought so too, but looking at equation 14, that didn’t seem to be the case. However, I assumed that he was using reasonable values for beta. The values he is using for beta are based on the ratio of years of life lost due to cycling fatalities versus fatalities from diseases which may in part be prevented by cycling (or other physical exercise). The results from his equations, which are based on typically rubbery assumptions (which horrify epidemiologists like myself) are very sensitive to the value of beta. The basis of his estimation of beta is quite wrong, I think – cycling fatalities are a tiny tip of the iceberg of cycling injuries, and the societal cost of non-fatal cycling head injuries is proportionally very large (compared to, say, cycling-related broken limb bones, which mostly heal). I suspect the true value of beta is less than 5, perhaps as low as 2 or 3. Using such values of beta, compulsory helmet laws suddenly look like a very good idea.

In summary, the author’s approach is not unreasonable, but he fails to actually measure any of the critical parameters in his equations, preferring instead to make assumptions about their values. I strongly suspect that several of his assumptions about the values of these parameters may be quite wrong, meaning that his conclusion is also likely to be quite wrong. There is no substitute for actually estimating parameters from real life observations and data, rather than making common sense but potentially very incorrect guesses about their values.

This is interesting- before I came upon this site, I’d never considered that not wearing a helmet was safe, and I’ve thought a lot about it.
My conclusion? When I’m riding my bike for exercise and wearing bike clothes and using clipless pedals, I wear a helmet. When I’m using my other bike as basically a quicker alternative to walking, riding slowly in my regular clothes- I don’t.

I’m an Australian cyclist. I’m also a motorcyclist.
I have some more anecdotal evidence and opinion.
There are mandatory helmet laws for motorcyclists Australia-wide. There are no laws regarding protection of other body parts! It is not unusual to see motorcyclists riding in shorts, t-shirts and thongs (that’s our polite word for flip-flops – open footwear) in our hot summers.
I had a motorcycle accident just over two years ago, at the end of summer. Despite the heat I was wearing boots, a leather jacket, gloves and a helmet. A careless motorist hadn’t seen me and turned across my path. I was travelling at about 50kmh before braking and I’d estimate about 20kmh at impact. I went clear over the car and landed on my side facing the the direction I had been coming from – a somersault. My Head and shoulders were the first to hit the ground. No damage to me. Visible damage to the helmet. I am in no doubt that there would have been damage to my person had I not been wearing protective equipment and clothing.
Regardless of the laws I would wear a helmet on a bicycle. I’m not the fastest cyclist around but I frequently see speeds over 40kmh.
I believe governments have a right and a responsibility to protect society from the excessive medical expenses incurred by careless and reckless individuals.
I should also note that here in Western Australia a percentage (my guess is about 10%) of the population ride without a helmet. Generally they will also ride on unlit streets at night without reflectors or lights. Enforcement of the helmet laws was pretty strong immediately after their introduction but has been pretty lax for years.

@ Gordon- As an American tax payer I am currently paying the Medicare costs of a country that has given its self diabetes, heart disease, STD’s, drug addiction…. the cost to me personally, and every other American, of other people’s preventable Type 2 diabetes is unfathomable. The number of brain injuries caused by bicycle accidents is minuscule compared to that. So to bring up the cost of bicycle injuries to the American public is silly.

I work in health care. Out of 100 patients I have seen in the past 3 months, none of them have had brain injury. I would say 80% of them had diabetes with serious complications like heart attack or limb amputation. Should we debate the cost of their medical care? After all, type 2 diabetes is 100% preventable.

No. I haven’t seen them because they are such a tiny percentage of the population, especially if you take out the ones who were not wearing helmets. In 11 years I have treated maybe 50 TBI patients. Of those, I can only remember 3 that were caused by bicycle accidents, and of those, only one was not wearing a helmet and two of the accidents were caused by reckless off road riding (at last count I had performed well over 20,000 treatments in this time period, so I can talk numbers). The causes of TBI that I have treated have been overwhelmingly caused by motor vehicle accidents (no bicycle involved).

Now, if you want to talk about common bike injuries- broken wrists and elbows are high up there. Shoulder injuries are also very common. I am surprised at the number of broken pelvises I have treated. Sprained wrists, broken knees, broken legs…… none which can be helped with helmets. Those are the traumatic ones. I spent 2 months working on the repetitive back and knee injuries a competitive cyclist gave himself, once. I know that that treatment, not including several surgeries, ended up costing his insurance over 50K dollars.

We can go around in circles on this. If you want to wear a helmet, do it. I do not, so I won’t. Do not push one on me and I won’t take yours away.

If you’re a health professional you should recognize the value of protecting your head in the event of a bicycle accident. But if you insist on setting a bad example, we’ll depend on you to spare us the expense of repairing the damage if you crash.

I’ve fallen off my bike twice in the past twenty years. Fortunately, I landed on my head (and gloved palms) both times–and split open only my helmet. The second time around I donated the split helmet to my physician, who hung it in her front office as a mute reminder of what a low speed fall from a bike can do to a human skull. I like to think that a few teenagers might have been spared by that example.

No one is anti-helmet, Gordon. Those who fall into the ‘anti’ anything group are anti- helmet law. There is a big difference.

If your argument is that those who ride without and get injured should not be covered by health insurance, then you must also insist that any illness or injury that could have been prevented but wasn’t should not be paid for either. You must also recognize the fact that the next step is to say that anyone who rides a bicycle should not be covered for their injuries in any circumstance because riding a bike involves the known risk of injury. In your case, with your argument, if I was a health insurance broker, you would be SOL on coverage.

I can site my personal bicycle accidents, as well. They were all my fault. I have damage to this day that will never go away. Should I have been given paid medical attention?

As you should know, the head is a heavy object and is very likely to hit the ground–hard–in any bicycle accident that involves a fall. That’s why helmets are so essential in preventing injuries to the head. Either one of my falls could easily have involved devastating head injuries, even death. Thanks to my helmet, I rode away from both falls with nothing more than a scraped knee.

As for the liability issues you raise, you may find that a “medical professional” cyclist who willfully refused to protect his head with a helmet, will have trouble obtaining compensation from an insurance company or employer for a cycling-related head injury. They’ll claim you were “negligent.” And I’m afraid they’d have a point.

Gordon,
Why do you refer to “facial reconstruction” in your original post, when helmets do nothing to protect the face? Nobody is anti-helmet here, just anti helmet LAWS. Wear your helmet and leave the rest of us alone. The cost of medical care in this country is ridiculously high for many reasons, but not because of accident victims. Insurance companies, drug companies, unscrupulous doctors and lawyers, etc. are to blame.